Changes to Clinical Trials, Health Outcomes Assessments and Value Propositions: Impact of the Two Selves Theory of Behavioral Economics.

In case you’ve not been keeping up with your psychology, there’s been a change in who we are. Behavioral economics research findings have revealed an equal partner to Freud’s egoic self, the concept of who we take ourselves to be. Our partner “me” is the percept of ourself—that which has remained unchanging and ever-present during our lifetime (Epstein, 2014; Kahneman, 2012; Pashko, 2014). Being a percept, it cannot be conceptualized though demonstrations of its savvy decision-making skills fill the behavioral economic research literature. Have a look at Lewicki (1988) if you have any reservations. Arguably, our perceptual, experiential self represents our more authentic existence because it exists prior to when we transform ourself into a concept.

Given that our perceptual self does not make decisions or view the world through the use of concepts the answers it provides to questions about its health status significantly differ from its partner’s view. Pain ratings from the rational-cognitive self include the percept of pain as well as concepts of what the pain “means” to the respondent. It reports a double negative if you will. But, with the experiential self only reporting the perceptual experience, the reported pain level is typically lower. Importantly, the two selves are not only implicated as a mechanism for the cause for placebo response and response shift but also touted as a reason for variations in the assessed value of the health outcomes produced by drugs and other therapies.

There’s quite a bit to reflect on for how two selves theory will change how clinical trials, outcomes research and drug value propositions are constructed and evaluated. Pharma companies will need to use additional assessment techniques to capture both of our views so clinical results, health outcomes and drug value estimates can be ascertained with more validity. Fortunately, there is now also hope that the confounding effects of the placebo response and response shift can be understood, controlled and countered.

Epstein, S. (2014). Cognitive-experiential theory. New York, NY: Oxford.

Kahneman, D. (2012). Thinking, fast and slow. New York, NY: Farrar, Straus & Giroux.

Lewicki, P., Hill, T., & Bizot, E. (1988). Acquisition of procedural knowledge about a pattern of stimuli that cannot be articulated. Cognitive Psychology, 20, 24 –37.

Pashko, S. (2014). Conceptual versus perceptual information processing: Implications for subjective reporting. Journal of Neuroscience, Psychology, and Economics, 7, 219–226.


Website: Steven

Copyright Steven Pashko, PhD (2017).

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